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Long JW, Jiang YL. Association of Small Airway Functional Indices With Respiratory Symptoms and Comorbidity in Asthmatics: A National Cross-Sectional Study. J Clin Med Res 2024; 16:220-231. [PMID: 38855778 PMCID: PMC11161183 DOI: 10.14740/jocmr5158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/20/2024] [Indexed: 06/11/2024] Open
Abstract
Background Small airway dysfunction (SAD) and airway inflammation are vital in asthma exacerbations. Type 2 inflammation (T2), mediated by cytokines from T helper 2 cell (Th2) such as interleukin (IL)-4, IL-5, and IL-13, is a potential mechanism underlying SAD. Research on small airway function in asthma is limited. We aimed to explore the correlation between small airway function and respiratory symptoms and comorbidity in T2 and non-T2 asthma. Methods Derived from the National Health and Nutrition Examination Survey (NHANES), our study encompassed 2,420 asthma patients aged 6 - 79 years, including pulmonary function (PF) data such as forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75), forced expiratory volume in 1 second (FEV1), forced expiratory volume in 3 seconds (FEV3), forced expiratory volume in 6 seconds (FEV6), and forced vital capacity (FVC). To evaluate the small airway function, we calculated z-scores for FEF25-75, FEF25-75/FVC, FEV1/FEV6, and FEV3/FEV6. Logistic regression determined the adjusted odds ratios (aORs) for symptoms and comorbidity. Results FEF25-75, FEV1/FEV6, and FEV3/FEV6 correlated with asthmatic symptoms. FEF25-75 had the strongest association with wheezing or whistling attacks. An increase of 1 standard deviations (SD) in FEF25-75 reduced recurrent wheezing (aOR: 0.70; 95% confidence intervals (95% CIs): 0.65 - 0.76) and severe attacks (aOR: 0.67; 95% CI: 0.62 - 0.94). These indices were also linked to dry cough and hay fever, particularly FEV3/FEV6 reducing hay fever risk (aOR: 0.70; 95% CI: 0.55 - 0.91) in non-T2 asthma. FEF25-75/FVC related to persistent (aOR: 0.78; 95% CI: 0.72 - 0.84) and severe attacks (aOR: 1.14; 95% CI: 1.08 - 1.22) in non-T2 groups. Lower indices combined with T2 exposure raised severe attack risk. Conclusions In this nationwide study, small airway function correlated with symptom onset, especially in T2 asthma. Small airway injury differed between T2 and non-T2 asthma. Prospective research is needed to establish reference values.
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Affiliation(s)
- Jia Wei Long
- Department of Respiratory Medicine, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yong Liang Jiang
- Department of Respiratory Medicine, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
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Alotaibi N, Borg BM, Abramson MJ, Paul E, Zwar N, Russell G, Wilson S, Holland AE, Bonevski B, Mahal A, George J. Different Case Finding Approaches to Optimise COPD Diagnosis: Evidence from the RADICALS Trial. Int J Chron Obstruct Pulmon Dis 2023; 18:1543-1554. [PMID: 37492489 PMCID: PMC10364814 DOI: 10.2147/copd.s371371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/28/2023] [Indexed: 07/27/2023] Open
Abstract
Aim Diagnosis of COPD in primary care is hindered by underuse of spirometry. Case finding using validated symptom and health status questionnaires, and simple handheld devices in high-risk populations may improve diagnosis. This study aimed to determine the best combination of measures to optimise COPD diagnosis in the primary care setting. Methods We recruited 335 current or ex-smokers, including those with an established diagnosis of COPD from general practices. Participants' FEV1 and FEV6 were measured using a handheld spirometry device (COPD-6®). Each completed the COPD assessment test (CAT), a modified Medical Research Council (mMRC) dyspnoea scale, St George's Respiratory Questionnaire (SGRQ) and smoking history questionnaire. From these data we calculated the predictive validity for spirometry-confirmed diagnosis of COPD. Area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated for each. Kappa coefficient was used to measure the agreement between the Fixed-Ratio (FR) and Lower Limit of Normal (LLN) spirometric criteria in diagnosing COPD. Results FEV1/FEV6 <0.70 alone showed significant association (p<0.0001) with COPD diagnosis and good predictive accuracy (AUROC=0.725). However, no further improvement was found after combining SGRQ, CAT and mMRC with FEV1/FEV6. FEV1/FEV6 <0.70 using the COPD-6® handheld device had moderate sensitivity (65.7%) and high PPV (90.1%), high specificity (79.3%) and NPV (44.8%). There was good agreement between FR and LLN definitions (κ=0.70). Conclusion Handheld micro-spirometers can facilitate case finding of COPD in smokers and ex-smokers attending general practice. The fixed ratio criterion currently recommended by COPD-X guidelines offers the simplest method for diagnosing COPD in Australian primary care.
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Affiliation(s)
- Nawar Alotaibi
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
| | - Brigitte M Borg
- Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Eldho Paul
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Grant Russell
- Department of General Practice, Monash University, Melbourne, VIC, Australia
| | - Sally Wilson
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
- Department of Infrastructure Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Anne E Holland
- Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Billie Bonevski
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Ajay Mahal
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Hill D, Torop M, Masoomi A, Castaldi PJ, Silverman EK, Bodduluri S, Bhatt SP, Yun T, McLean CY, Hormozdiari F, Dy J, Cho MH, Hobbs BD. Deep Learning Utilizing Suboptimal Spirometry Data to Improve Lung Function and Mortality Prediction in the UK Biobank. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.28.23289178. [PMID: 37162978 PMCID: PMC10168495 DOI: 10.1101/2023.04.28.23289178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Spirometry measures lung function by selecting the best of multiple efforts meeting pre-specified quality control (QC), and reporting two key metrics: forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). We hypothesize that discarded submaximal and QC-failing data meaningfully contribute to the prediction of airflow obstruction and all-cause mortality. Methods We evaluated volume-time spirometry data from the UK Biobank. We identified "best" spirometry efforts as those passing QC with the maximum FVC. "Discarded" efforts were either submaximal or failed QC. To create a combined representation of lung function we implemented a contrastive learning approach, Spirogram-based Contrastive Learning Framework (Spiro-CLF), which utilized all recorded volume-time curves per participant and applied different transformations (e.g. flow-volume, flow-time). In a held-out 20% testing subset we applied the Spiro-CLF representation of a participant's overall lung function to 1) binary predictions of FEV1/FVC < 0.7 and FEV1 Percent Predicted (FEV1PP) < 80%, indicative of airflow obstruction, and 2) Cox regression for all-cause mortality. Findings We included 940,705 volume-time curves from 352,684 UK Biobank participants with 2-3 spirometry efforts per individual (66.7% with 3 efforts) and at least one QC-passing spirometry effort. Of all spirometry efforts, 24.1% failed QC and 37.5% were submaximal. Spiro-CLF prediction of FEV1/FVC < 0.7 utilizing discarded spirometry efforts had an Area under the Receiver Operating Characteristics (AUROC) of 0.981 (0.863 for FEV1PP prediction). Incorporating discarded spirometry efforts in all-cause mortality prediction was associated with a concordance index (c-index) of 0.654, which exceeded the c-indices from FEV1 (0.590), FVC (0.559), or FEV1/FVC (0.599) from each participant's single best effort. Interpretation A contrastive learning model using raw spirometry curves can accurately predict lung function using submaximal and QC-failing efforts. This model also has superior prediction of all-cause mortality compared to standard lung function measurements. Funding MHC is supported by NIH R01HL137927, R01HL135142, HL147148, and HL089856.BDH is supported by NIH K08HL136928, U01 HL089856, and an Alpha-1 Foundation Research Grant.DH is supported by NIH 2T32HL007427-41EKS is supported by NIH R01 HL152728, R01 HL147148, U01 HL089856, R01 HL133135, P01 HL132825, and P01 HL114501.PJC is supported by NIH R01HL124233 and R01HL147326.SPB is supported by NIH R01HL151421 and UH3HL155806.TY, FH, and CYM are employees of Google LLC.
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Affiliation(s)
- Davin Hill
- Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Max Torop
- Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, USA
| | - Aria Masoomi
- Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, USA
| | - Peter J. Castaldi
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Sandeep Bodduluri
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | - Jennifer Dy
- Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, USA
| | - Michael H. Cho
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Brian D. Hobbs
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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Benfante A, Tomasello A, Gianquinto E, Cicero MN, Scichilone N. Diagnostic and therapeutic approaches for elderly asthma patients: the importance of multidisciplinary and multidimensional management. Expert Rev Respir Med 2023; 17:459-468. [PMID: 37194689 DOI: 10.1080/17476348.2023.2215432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 05/15/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Asthma is commonly considered a disease of younger ages; however, it is not infrequent to pose a diagnosis of the disease in older individuals. Although current recommendations do not distinguish between young and old asthmatics in terms of diagnostic and therapeutic approaches, asthma in the elderly may present with peculiar features that contribute to complicate its management. AREAS COVERED The current review focuses on the challenges that arise when approaching an older individual with suspected asthma. Age-associated changes of the lung may complicate the diagnostic approach. Measurement of the forced expiratory volume in the first 6 s (FEV6) in an easier and faster alternative to FVC estimation, and residual volume should always be assessed. Older individuals are often affected by concomitant diseases, both age- and drug-related, that need to be considered when approaching elderly asthmatics, since they can affect the efficacy of the treatment as well as the control of the disease. EXPERT OPINION The potential drug to drug interaction should be routinely investigated, and documented in medical records. The effect of aging on the response to pharmacological therapy in older asthmatics should be explored. Therefore, the need of a multidisciplinary and multidimensional approach to the elderly asthmatics is strongly encouraged.
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Affiliation(s)
- Alida Benfante
- PROMISE Department, University of Palermo, Palermo, Italy
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Lungenfunktionsprüfung im höheren Lebensalter. Z Gerontol Geriatr 2022; 55:603-612. [DOI: 10.1007/s00391-022-02070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/03/2022] [Indexed: 10/14/2022]
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Perpiñá M, Gómez-Bastero A, Trisán A, Martínez-Moragón E, Álvarez-Gutiérrez FJ, Urrutia I, Blanco-Aparicio M. Expert consensus recommendations for the management of asthma in older adults. Med Clin (Barc) 2022; 159:53.e1-53.e14. [PMID: 34226059 DOI: 10.1016/j.medcli.2021.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 10/20/2022]
Abstract
Asthma is a public health problem in patients of any age, although there is still a tendency to erroneously assume that it is almost always confined to children and young people. Epidemiological studies indicate that, from the sixth decade of life, the prevalence of this disease in countries such as Spain reaches 6-10%, with a higher prevalence among women aged 64 to 75 years. In addition, two-thirds of asthma deaths occur at this stage of life, resulting in a substantial number of hospital admissions, longer hospital stays and, from a finance point of view, significant direct economic costs. Asthma in older adults (65 years or older) is now a matter of great concern, the reality of which is underestimated and undertreated. It is therefore essential to establish appropriate recommendations for the diagnosis and treatment of asthma in the aging population. This consensus, which brings together the latest evidence available, was conceived with this objective. The proposed recommendations/conclusions are the result of a nominal consensus developed throughout 2019 and validated by panellists in successive rounds of voting.
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Affiliation(s)
- Miguel Perpiñá
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - Andrea Trisán
- Servicio de Neumología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | | | - Isabel Urrutia
- Unidad de Asma y Enfermedades Ocupacionales-Medioambientales, Servicio de Neumología, Hospital Galdakao-Usansolo, Bizkaia, España
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Association Between Depression, Lung Function, and Inflammatory Markers in Patients with Asthma and Occupational Asthma. J Occup Environ Med 2020; 61:453-460. [PMID: 30855523 DOI: 10.1097/jom.0000000000001562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Depression is associated with autonomic and immune dysregulation, yet this remains poorly explored in asthma. We assessed associations between depressive disorder, lung function, and inflammatory markers in patients under investigation for occupational asthma (OA). METHODS One hundred twelve patients under investigation for OA (60% men) underwent a psychiatric interview to assess depressive disorder, and spirometry, a methacholine test, sputum induction, and specific inhalation challenge (SIC) to assess OA. Blood and sputum inflammatory markers were assessed. RESULTS There was a statistically significant association between depressive disorder (P = 0.0195) and forced expiratory volume in 1 second (FEV1) responses, with the drop in FEV1 post-SIC smaller in patients with OA and depression, versus OA with no depression (P < 0.001). CONCLUSION The presence of depressive disorder may influence FEV1 in patients with OA, which may be via autonomic pathways. However, further studies are warranted in order to determine the mechanisms that underlie these effects.
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Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, Hallstrand TS, Kaminsky DA, McCarthy K, McCormack MC, Oropez CE, Rosenfeld M, Stanojevic S, Swanney MP, Thompson BR. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med 2020; 200:e70-e88. [PMID: 31613151 PMCID: PMC6794117 DOI: 10.1164/rccm.201908-1590st] [Citation(s) in RCA: 1696] [Impact Index Per Article: 424.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Spirometry is the most common pulmonary function test. It is widely used in the assessment of lung function to provide objective information used in the diagnosis of lung diseases and monitoring lung health. In 2005, the American Thoracic Society and the European Respiratory Society jointly adopted technical standards for conducting spirometry. Improvements in instrumentation and computational capabilities, together with new research studies and enhanced quality assurance approaches, have led to the need to update the 2005 technical standards for spirometry to take full advantage of current technical capabilities.Methods: This spirometry technical standards document was developed by an international joint task force, appointed by the American Thoracic Society and the European Respiratory Society, with expertise in conducting and analyzing pulmonary function tests, laboratory quality assurance, and developing international standards. A comprehensive review of published evidence was performed. A patient survey was developed to capture patients' experiences.Results: Revisions to the 2005 technical standards for spirometry were made, including the addition of factors that were not previously considered. Evidence to support the revisions was cited when applicable. The experience and expertise of task force members were used to develop recommended best practices.Conclusions: Standards and consensus recommendations are presented for manufacturers, clinicians, operators, and researchers with the aims of increasing the accuracy, precision, and quality of spirometric measurements and improving the patient experience. A comprehensive guide to aid in the implementation of these standards was developed as an online supplement.
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Bouza E, Alvar A, Almagro P, Alonso T, Ancochea J, Barbé F, Corbella J, Gracia D, Mascarós E, Melis J, Miravitlles M, Pastor M, Pérez P, Rudilla D, Torres A, Soriano JB, Vallano A, Vargas F, Palomo E. Chronic obstructive pulmonary disease (COPD) in Spain and the different aspects of its social impact: a multidisciplinary opinion document. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2020; 33:49-67. [PMID: 31933347 PMCID: PMC6987629 DOI: 10.37201/req/2064.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/24/2019] [Accepted: 12/02/2019] [Indexed: 12/21/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases in the World, and one of the most important causes of mortality and morbidity. In adults 40 years and older, it affects more than 10% of the population and has enormous personal, family and social burden. Tobacco smoking is its main cause, but not the only one, and there is probably a genetic predisposition that increases the risk in some patients. The paradigm of this disease is changing in Spain, with an increase of women that has occurred in recent years. Many of the physio pathological mechanisms of this condition are well known, but the psychological alterations to which it leads, the impact of COPD on relatives and caregivers, the limitation of daily life observed in these patients, and the economic and societal burden that they represent for the health system, are not so well-known. A major problem is the high under-diagnosis, mainly due to difficulties for obtaining, in a systematic way, spirometries in hospitals and health-care centers. For this reason, the Fundación de Ciencias de la Salud and the Spanish National Network Center for Research in Respiratory Diseases (CIBERES) have brought together experts in COPD, patients and their organizations, clinical psychologists, experts in health economics, nurses and journalists to obtain their opinion about COPD in Spain. They also discussed the scientific bibliometrics on COPD that is being carried out from the CIBERES and speculated on the future of this condition. The format of the meeting consisted in the discussion of a series of questions that were addressed by different speakers and discussed until a consensus conclusion was reached.
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Affiliation(s)
- E Bouza
- Emilio Bouza MD, PhD, Instituto de Investigación Sanitaria Gregorio Marañón, C/ Dr. Esquerdo, 46 - 28007 Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Palomo
- Esteban Palomo, PhD, Director. Fundación de Ciencias de la Salud. C/ Severo Ochoa, 2, - 28760 Tres Cantos. Madrid, Spain. Phone +34 91 3530150
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Komal S, Simon L, Grau G, Mateu A, de la Asunción Villaverde M, de la Sierra A, Almagro P. Utility of FEV1/FEV6 index in patients with multimorbidity hospitalized for decompensation of chronic diseases. PLoS One 2019; 14:e0220491. [PMID: 31374087 PMCID: PMC6677320 DOI: 10.1371/journal.pone.0220491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 07/17/2019] [Indexed: 12/25/2022] Open
Abstract
Spirometry remains essential for the diagnosis of airway obstruction. Nevertheless, its performance in elderly hospitalized patients with multimorbidity can be difficult. The aim of this study is to assess the utility of the COPD-6 portable device in this population. We included all patients hospitalized for exacerbation of chronic diseases in a medical ward specialized in the care of multimorbidity patients, between September 2017 and May 2018. A questionnaire including sociodemographic, cognitive and functional impairment, among other variables, was completed the last day of admission. Subsequently, patients attempted to perform three valid respiratory manoeuvres with the COPD-6 device and then conventional spirometry. A total of 184 patients were included (mean age of 79.61 years, 55% men). Forty-seven (25.54%) patients were able to perform complete spirometric manoeuvres and 99 (53.8%) could perform a valid FEV1/FEV6 determination. The inability to perform a valid spirometry was related with the patient’s age, functional physical disability, cognitive impairment or the presence of delirium or dysphagia during admission. Only 9% of patients with a Mini Mental Cognitive Examination (MMEC) lower than 24 points could perform a valid spirometry. Of the patients with an MMEC < 24 points and unable to perform spirometry, 34% were able to complete the FEV1/FEV6 manoeuvres. No differences were found in the Charlson index, multimorbidity scale, number of domiciliary drugs, or length of stay between those patients able and those not able to perform respiratory manoeuvres. The agreement between the values for FEV1 measured with COPD-6 and those observed in the spirometry was good (r: 0.71; p<0.0001). Inability to perform a valid spirometry during hospitalization in elderly patients with multimorbidity is frequent and related with functional and cognitive impairment. FEV1/FEV6 determination using the COPD-6 portable device allows an important percentage of the patients with limitations to complete spirometric measurement.
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Affiliation(s)
- Shakeel Komal
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
- Internal Medicine Department, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Lluis Simon
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
- Internal Medicine Department, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Gemma Grau
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
- Internal Medicine Department, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Aina Mateu
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
- Internal Medicine Department, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Maria de la Asunción Villaverde
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
- Internal Medicine Department, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Alex de la Sierra
- Internal Medicine Department, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
| | - Pere Almagro
- Multimorbidity Unit, Internal Medicine Service, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
- Internal Medicine Department, University Hospital Mutua de Terrassa, University of Barcelona, Terrassa, Spain
- * E-mail:
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Aggarwal AN, Agarwal R, Dhooria S, Prasad KT, Sehgal IS, Muthu V, Singh N, Behera D, Jindal SK, Singh V, Chawla R, Samaria JK, Gaur SN, Agrawal A, Chhabra SK, Chopra V, Christopher DJ, Dhar R, Ghoshal AG, Guleria R, Handa A, Jain NK, Janmeja AK, Kant S, Khilnani GC, Kumar R, Mehta R, Mishra N, Mohan A, Mohapatra PR, Patel D, Ram B, Sharma SK, Singla R, Suri JC, Swarnakar R, Talwar D, Narasimhan RL, Maji S, Bandopadhyay A, Basumatary N, Mukherjee A, Baldi M, Baikunje N, Kalpakam H, Upadhya P, Kodati R. Joint Indian Chest Society-National College of Chest Physicians (India) guidelines for spirometry. Lung India 2019; 36:S1-S35. [PMID: 31006703 PMCID: PMC6489506 DOI: 10.4103/lungindia.lungindia_300_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although a simple and useful pulmonary function test, spirometry remains underutilized in India. The Indian Chest Society and National College of Chest Physicians (India) jointly supported an expert group to provide recommendations for spirometry in India. Based on a scientific grading of available published evidence, as well as other international recommendations, we propose a consensus statement for planning, performing and interpreting spirometry in a systematic manner across all levels of healthcare in India. We stress the use of standard equipment, and the need for quality control, to optimize testing. Important technical requirements for patient selection, and proper conduct of the vital capacity maneuver, are outlined. A brief algorithm to interpret and report spirometric data using minimal and most important variables is presented. The use of statistically valid lower limits of normality during interpretation is emphasized, and a listing of Indian reference equations is provided for this purpose. Other important issues such as peak expiratory flow, bronchodilator reversibility testing, and technician training are also discussed. We hope that this document will improve use of spirometry in a standardized fashion across diverse settings in India.
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Affiliation(s)
- Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - KT Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul S Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - D Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - SK Jindal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Chawla
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - JK Samaria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - SN Gaur
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anurag Agrawal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - SK Chhabra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Chopra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - DJ Christopher
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raja Dhar
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aloke G Ghoshal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Randeep Guleria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Handa
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nirmal K Jain
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok K Janmeja
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surya Kant
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - GC Khilnani
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raj Kumar
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravindra Mehta
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anant Mohan
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - PR Mohapatra
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dharmesh Patel
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Babu Ram
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - SK Sharma
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupak Singla
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - JC Suri
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Swarnakar
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Talwar
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Lakshmi Narasimhan
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saurabh Maji
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankan Bandopadhyay
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nita Basumatary
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arindam Mukherjee
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Milind Baldi
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandkishore Baikunje
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hariprasad Kalpakam
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pratap Upadhya
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kodati
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Tian XY, Liu CH, Wang DX, Ji XL, Shi H, Zheng CY, Xie MS, Xiao W. Spirometric Reference Equations for Elderly Chinese in Jinan Aged 60-84 Years. Chin Med J (Engl) 2018; 131:1016-1022. [PMID: 29553052 PMCID: PMC5937307 DOI: 10.4103/0366-6999.227840] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: The interpretation of spirometry varies on different reference values. Older people are usually underrepresented in published predictive values. This study aimed at developing spirometric reference equations for elderly Chinese in Jinan aged 60–84 years and to compare them to previous equations. Methods: The project covered all of Jinan city, and the recruitment period lasted 9 months from January 1, 2017 to September 30, 2017, 434 healthy people aged 60–84 years who had never smoked (226 females and 208 males) were recruited to undergo spirometry. Vital capacity (VC), forced VC (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, FEV1/VC, FEV6, peak expiratory flow, and forced expiratory flow at 25%, 50%, 75%, and 25–75% of FVC exhaled (FEF25%, FEF50%, FEF75%, and FEF25–75%) were analyzed. Reference equations for mean and the lower limit of normal (LLN) were derived using the lambda-mu-sigma method. Comparisons between new and previous equations were performed by paired t-test. Results: New reference equations were developed from the sample. The LLN of FEV1/FVC, FEF25–75% computed using the 2012-Global Lung Function Initiative (GLI) and 2006-Hong Kong equations were both lower than the new equations. The biggest degree of difference for FEV1/FVC was 19% (70.46% vs. 59.29%, t = 33.954, P < 0.01) and for maximal midexpiratory flow (MMEF, equals to FEF25–75%) was 22% (0.82 vs. 0.67, t = 21.303, P < 0.01). The 1990-North China and 2009-North China equations predicted higher mean values of FEV1/FVC and FEF25–75% than the present model. The biggest degrees of difference were −4% (78.31% vs. 81.27%, t = −85.359, P < 0.01) and −60% (2.11 vs. 4.68, t = −170.287, P < 0.01), respectively. Conclusions: The newly developed spirometric reference equations are applicable to elderly Chinese in Jinan. The 2012-GLI and 2006-Hong Kong equations may lead to missed diagnoses of obstructive ventilatory defects and the small airway dysfunction, while traditional linear equations for all ages may lead to overdiagnosis.
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Affiliation(s)
- Xin-Yu Tian
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Chun-Hong Liu
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - De-Xiang Wang
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Xiu-Li Ji
- Department of Pulmonary Disease, Jinan Traditional Chinese Medicine Hospital, Jinan, Shandong 250012, China
| | - Hui Shi
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Chun-Yan Zheng
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Meng-Shuang Xie
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
| | - Wei Xiao
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China
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Abstract
Late-onset asthma is common, associated with poor outcome, underdiagnosed and undertreated, possibly due to the modifying effect of ageing on disease expression. Although the diagnostic work-up in elderly individuals suspected of having asthma follows the same steps as in younger individuals (case history and spirometry), it is important to acknowledge that elderly individuals are likely to have diminished bronchodilator reversibility and some degree of fixed airflow obstruction. Elderly individuals, therefore, often require further objective tests, including bronchial challenge testing, to objectively confirm asthma. If necessary, a trial of oral or inhaled corticosteroid might be necessary. Asthma can be diagnosed when increased airflow variability is identified in a symptomatic patient, and if the patient does not have a history of exposure, primarily smoking, known to cause chronic obstructive pulmonary disease, the diagnosis is asthma even if the patient does not have fully reversible airflow obstruction. Pharmacological therapy in patients with late-onset asthma follows international guidelines, including treatment with the lowest effective dose of inhaled corticosteroid to minimize the risk of systemic effects. However, most recommendations are based on extrapolation from findings in younger patients. Comorbidities are very common in patients with late-onset asthma and need to be taken into account in the management of the disease. In conclusion, late-onset asthma is poorly recognized and sub-optimally treated, the latter not least because elderly patients are excluded from most randomized controlled trials. Future studies should focus on the development of evidence-based guidelines for diagnosis and the pharmacological therapy of asthma in the elderly, including late-onset asthma.
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Affiliation(s)
- Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre Hospital, 2650, Hvidovre, Denmark. .,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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14
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Occhipinti M, Larici AR, Bonomo L, Incalzi RA. Aging Airways: between Normal and Disease. A Multidimensional Diagnostic Approach by Combining Clinical, Functional, and Imaging Data. Aging Dis 2017; 8:471-485. [PMID: 28840061 PMCID: PMC5524809 DOI: 10.14336/ad.2016.1215] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/15/2016] [Indexed: 12/30/2022] Open
Abstract
The lack of data on lung function decline in the aging process as well as the lack of gold standards to define obstructive and restrictive respiratory disease in older people point out the need for a multidimensional assessment and interpretation of the aging airways. By integrating clinical data together with morphologic and morphometric findings clinicians can assess the airways with a more comprehensive perspective, helpful in the interpretation of the "grey zone" between normal aging and disease. This review focuses on the value of a multidimensional approach in the study of the aging airways, including clinical findings, respiratory function tests, and imaging as parts of a whole. Nowadays this multidimensional diagnostic approach can be used in daily clinical practice. In next future, it can be implemented by the analysis of exhaled gases, post-processing imaging techniques, and genetic analysis, that will hopefully reduce the gaps in knowledge of normal aging and airway disease in older people.
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Affiliation(s)
- Mariaelena Occhipinti
- Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50134 Florence, Italy
- Department of Radiological Sciences, Gemelli Hospital, Catholic University of Sacred Heart, 00168 Roma, Italy
| | - Anna Rita Larici
- Department of Radiological Sciences, Gemelli Hospital, Catholic University of Sacred Heart, 00168 Roma, Italy
| | - Lorenzo Bonomo
- Department of Radiological Sciences, Gemelli Hospital, Catholic University of Sacred Heart, 00168 Roma, Italy
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Thorat YT, Salvi SS, Kodgule RR. Peak flow meter with a questionnaire and mini-spirometer to help detect asthma and COPD in real-life clinical practice: a cross-sectional study. NPJ Prim Care Respir Med 2017; 27:32. [PMID: 28487516 PMCID: PMC5435090 DOI: 10.1038/s41533-017-0036-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/23/2017] [Accepted: 04/04/2017] [Indexed: 12/23/2022] Open
Abstract
Peak flow meter with questionnaire and mini-spirometer are considered as alternative tools to spirometry for screening of asthma and chronic obstructive pulmonary disease. However, the accuracy of these tools together, in clinical settings for disease diagnosis, has not been studied. Two hundred consecutive patients with respiratory complaints answered a short symptom questionnaire and performed peak expiratory flow measurements, standard spirometry with Koko spirometer and mini-spirometry (COPD-6). Spirometry was repeated after bronchodilation. Physician made a final diagnosis of asthma, chronic obstructive pulmonary disease and others. One eighty nine patients (78 females) with age 51 ± 17 years with asthma (115), chronic obstructive pulmonary disease (33) and others (41) completed the study. "Breathlessness > 6months" and "cough > 6months" were important symptoms to detect obstructive airways disease. "Asymptomatic period > 2 weeks" had the best sensitivity (Sn) and specificity (Sp) to differentiate asthma and chronic obstructive pulmonary disease. A peak expiratory flow of < 80% predicted was the best cut-off to detect airflow limitation (Sn 90%, Sp 50%). Respiratory symptoms with PEF < 80% predicted, had Sn 84 and Sp 93% to detect OAD. COPD-6 device under-estimated FEV1 by 13 mL (95% CI: -212, 185). At a cut-off of 0.75, the FEV1/FEV6 had the best accuracy (Sn 80%, Sp 86%) to detect airflow limitation. Peak flow meter with few symptom questions can be effectively used in clinical practice for objective detection of asthma and chronic obstructive pulmonary disease, in the absence of good quality spirometry. Mini-spirometers are useful in detection of obstructive airways diseases but FEV1 measured is inaccurate. CHRONIC LUNG DISEASES DIFFERENTIATING CONDITIONS IN POORLY-EQUIPPED SETTINGS: A simple questionnaire and peak flow meter measurements can help doctors differentiate between asthma and chronic lung disease. In clinical settings where access to specialist equipment and knowledge is limited, it can be challenging for doctors to tell the difference between asthma and chronic obstructive pulmonary disease (COPD). To determine a viable alternative method for differentiating between these diseases, Rahul Kodgule and colleagues at the Chest Research Foundation in Pune, India, trialed a simplified version of two existing symptom questionnaires, combined with peak flow meter measurements. They assessed 189 patients using this method, and found it aided diagnosis with high sensitivity and specificity. Breathlessness, cough and wheeze were the minimal symptoms required for COPD diagnosis, while the length of asymptomatic periods was most helpful in distinguishing asthma from COPD.
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Affiliation(s)
- Yogesh T Thorat
- Chest Research Foundation, Marigold Premises, Kalyani Nagar, Pune, 411014, India
| | - Sundeep S Salvi
- Chest Research Foundation, Marigold Premises, Kalyani Nagar, Pune, 411014, India
| | - Rahul R Kodgule
- Chest Research Foundation, Marigold Premises, Kalyani Nagar, Pune, 411014, India.
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16
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Chung KS, Jung JY, Park MS, Kim YS, Kim SK, Chang J, Song JH. Cut-off value of FEV1/FEV6 as a surrogate for FEV1/FVC for detecting airway obstruction in a Korean population. Int J Chron Obstruct Pulmon Dis 2016; 11:1957-63. [PMID: 27578970 PMCID: PMC4998021 DOI: 10.2147/copd.s113568] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Forced expiratory volume in 1 second (FEV1)/forced expiratory volume in 6 seconds (FEV6) has been proposed as an alternative to FEV1/forced vital capacity (FVC) for detecting airway obstruction. A fixed cut-off value for FEV1/FEV6 in a Korean population is lacking. We investigated a fixed cut-off for FEV1/FEV6 as a surrogate for FEV1/FVC for detecting airway obstruction. Materials and methods We used data obtained in the 5 years of the Fifth and Sixth Korean National Health and Nutrition Examination Survey. A total of 14,978 participants aged ≥40 years who underwent spirometry adequately were the study cohort. “Airway obstruction” was a fixed cut-off FEV1/FVC <70% according to the Global Initiative for Chronic Obstructive Lung Disease guidelines. We also used European Respiratory Society/Global Lung Initiative 2012 equations for the FEV1/FVC lower limit of normal. Results Among the 14,978 participants (43.5% male, 56.5% female; mean age: 56.9 years for men and 57.0 years for women), 14.0% had obstructive lung function according to a fixed cut-off FEV1/FVC <70%. Optimal FEV1/FEV6 cut-off for predicting FEV1/FVC <70% was 75% using receiver operating characteristic curve analyses (area under receiver operating characteristic curve =0.989, 95% confidence interval 0.987–0.990). This fixed cut-off of FEV1/FEV6 showed 93.8% sensitivity, 94.8% specificity, 74.7% positive predictive value, 98.9% negative predictive value, and 0.8 Cohen’s kappa coefficient. When compared with FEV1/FVC < lower limit of normal, FEV1/FEV6 <75% tended to over-diagnose airflow limitation (just like a fixed cut-off of FEV1/FVC <70%). When grouped according to age and FEV1 (%), FEV1/FEV6 <75% diagnosed more airway obstruction in older participants and mild–moderate stages compared with FEV1/FVC <70%. Conclusion A valid fixed cut-off for detecting airway obstruction in a Korean population is FEV1/FEV6 of 75%, but should be used with caution in older individuals and those with mild–moderate airway obstruction.
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Affiliation(s)
- Kyung Soo Chung
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Ye Jung
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moo Suk Park
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Sam Kim
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se Kyu Kim
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Chang
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joo Han Song
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Benfante A, Scichilone N. The geriatric asthma: pitfalls and challenges. Asthma Res Pract 2016; 2:2. [PMID: 27965770 PMCID: PMC5142431 DOI: 10.1186/s40733-015-0018-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 12/19/2015] [Indexed: 11/10/2022] Open
Abstract
Historically, asthma has been envisioned as a disease of younger ages. This has led to the assumption that respiratory symptoms suggestive of asthma occurring in older ages are to be attributed to conditions other than asthma, mainly COPD. Old observational reports and new epidemiological studies confirm that asthma is as frequent in older as it is in younger populations. Nevertheless, under-recognition, misdiagnosis and under-treatment are still relevant issues. The characterization of asthma in the aged suffers from the fact that there has been very little original research in this field. Indeed, geriatric asthma is often excluded from clinical trials because of age and comorbidities. The current review paper revises the areas that need to be elucidated, and highlights the gaps in the management of this condition. It follows that a multidimensional management is advocated for elderly asthmatics to evaluate the severity and establish the complexity of the disease. We suggest that the term “geriatric” asthma should be preferred to “senile” asthma, which is confined to the age-related changes in the lung, or the more generic “asthma in the elderly”, which is only descriptive of the prevalence in specific age groups.
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Affiliation(s)
- Alida Benfante
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Istituto Euro-Mediterraneo di Scienza e Tecnologia, via Trabucco 180, 90146 Palermo, Italy
| | - Nicola Scichilone
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Istituto Euro-Mediterraneo di Scienza e Tecnologia, via Trabucco 180, 90146 Palermo, Italy.,Euro-Mediterranean Institute of Science and Technology, Palermo, Italy
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18
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Prognostic Value of the Six-Second Spirometry in Patients with Chronic Obstructive Pulmonary Disease: A Cohort Study. PLoS One 2015; 10:e0140855. [PMID: 26489023 PMCID: PMC4619273 DOI: 10.1371/journal.pone.0140855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/01/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The six-second spirometry has been proposed as an alternative to diagnose airflow limitation, although its prognostic value in patients with chronic obstructive pulmonary disease (COPD) remains unknown. The purpose of this study was to determine the prognostic value of the postbronchodilator forced expiratory volume in 1 second (FEV1)/forced expiratory volume in 6 seconds (FEV6) ratio and FEV6 in COPD patients. METHODS AND FINDINGS The study population consisted of 2,614 consecutive stable patients with COPD. The patients were monitored for an average period of 4.3 years regarding mortality, hospitalizations by COPD exacerbations, diagnosis of lung cancer, and annual lung function decline. The overall rate of death was 10.7 (95%CI: 8.7-12.7) per 1000 person-years. In addition to male gender, age and comorbidity, FEV6 (hazard ratio [HR]: 0.981, 95%CI: 0.968-0.003) and FEV1/FEV6 quartiles (lowest quartile (<74% pred.): HR 3.558, 95%CI: 1.752-7.224; and second quartile (74-84% pred.): HR 2.599, 95%CI: 1.215-5.561; versus best quartile (>0.89% pred.)) were independently associated with mortality, whereas FEV1 was not retained in the model. 809 patients (30.9%) had at least one hospital admission due to COPD exacerbation. In addition to sex, age, smoking and comorbidity, FEV1 and FEV1/FEV6 quartiles were independent risk factors of hospitalization. FEV6 was the only spirometric parameter independently related with lung function annual decline, while the FEV6 and FEV1/FEV6 quartiles were independent risk factors for lung cancer. CONCLUSIONS In a general COPD outpatient population, airflow obstruction assessed by the FEV1/FEV6 is an independent risk factor for both death and hospitalization.
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19
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Zairina E, Abramson MJ, McDonald CF, Rochford P, Nolan G, Stewart K, Paul E, Walker SP, George J. A prospective cohort study of pulmonary function during pregnancy in women with and without asthma. J Asthma 2015; 53:155-63. [PMID: 26365313 DOI: 10.3109/02770903.2015.1080268] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Pregnancy alters the severity of asthma unpredictably. Uncertainty still exists about longitudinal changes in pulmonary function during pregnancy in both healthy and asthmatic women. This study aimed to compare pulmonary function changes during pregnancy in healthy and asthmatic women and to determine the relationship between pulmonary function and asthma-related quality of life during pregnancy. A secondary aim was to investigate the application of forced expiratory volume in 6 s (FEV6) for monitoring asthma during pregnancy. METHODS Pregnant women with (n = 20) and without asthma (n = 20) had pulmonary function tests at 8-20, 21-28 and 29-40 weeks gestation. Those with asthma also completed the Asthma Control Questionnaire (ACQ) and mini Asthma Quality of Life Questionnaire (mAQLQ) at each visit. RESULTS Pulmonary function declined in both groups at follow-up #1 (more markedly in those with asthma) but then improved at follow-up #2 (more markedly in those with asthma). In those with asthma, ACQ scores increased, while mAQLQ scores declined at follow-up #1; whilst at follow-up #2 these changes were in the opposite direction. FEV6 and forced vital capacity (FVC) were highly correlated (r = 0.88, p < 0.01) in asthmatics. CONCLUSIONS Pulmonary function changes during second and third trimesters were more pronounced in asthmatics than in healthy women. FEV6 monitoring may assist pregnant women and their health professionals in optimizing asthma management. The changes in pulmonary function in women with asthma were not significantly associated with changes in asthma control or asthma-related quality of life.
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Affiliation(s)
- Elida Zairina
- a Centre for Medicine Use and Safety, Monash University , Parkville , Victoria , Australia
| | - Michael J Abramson
- b Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Victoria , Australia .,c Department of Allergy, Immunology & Respiratory Medicine , The Alfred Hospital, Melbourne , Victoria , Australia
| | - Christine F McDonald
- d Department of Respiratory and Sleep Medicine , The Austin Hospital , Heidelberg , Victoria , Australia
| | - Peter Rochford
- d Department of Respiratory and Sleep Medicine , The Austin Hospital , Heidelberg , Victoria , Australia
| | - Gary Nolan
- e Department of Respiratory and Sleep Medicine , The Townsville Hospital , Douglas , Queensland , Australia
| | - Kay Stewart
- a Centre for Medicine Use and Safety, Monash University , Parkville , Victoria , Australia
| | - Eldho Paul
- b Department of Epidemiology and Preventive Medicine , Monash University , Melbourne , Victoria , Australia .,f Department of Clinical Haematology , The Alfred Hospital , Melbourne , Victoria
| | - Susan P Walker
- g Department of Maternal Fetal Medicine , Mercy Hospital for Women , Heidelberg , Australia , and.,h Department of Obstetrics and Gynecology , University of Melbourne , Parkville , Victoria , Australia
| | - Johnson George
- a Centre for Medicine Use and Safety, Monash University , Parkville , Victoria , Australia
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20
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Sui CF, Ming LC, Neoh CF, Ibrahim B. VitalQPlus: a potential screening tool for early diagnosis of COPD. Int J Chron Obstruct Pulmon Dis 2015; 10:1613-22. [PMID: 26316735 PMCID: PMC4541542 DOI: 10.2147/copd.s84618] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study utilized a validated combination of a COPD Population Screener (COPD-PS) questionnaire and a handheld spirometric device as a screening tool for patients at high risk of COPD, such as smokers. The study aimed to investigate and pilot the feasibility and application of this combined assessment, which we termed the "VitalQPlus", as a screening tool for the early detection of COPD, especially in primary care settings. METHODS This was a cross-sectional study screening potentially undiagnosed COPD patients using a validated five-item COPD-PS questionnaire together with a handheld spirometric device. Patients were recruited from selected Malaysian government primary care health centers. RESULTS Of the total of 83 final participants, only 24.1% (20/83) were recruited from Perak and Penang (peninsular Malaysia) compared to 75.9% (63/83) from Sabah (Borneo region). Our dual assessment approach identified 8.4% of the surveyed patients as having potentially undiagnosed COPD. When only the Vitalograph COPD-6 screening tool was used, 15.8% of patients were detected with a forced expiratory volume in 1 second/forced expiratory volume in 6 seconds (FEV1/FEV6) ratio at <0.75, while 35.9% of patients were detected with the COPD-PS questionnaire. These findings suggested that this dual assessment approach has a greater chance of identifying potentially undiagnosed COPD patients compared to the Vitalograph COPD-6 or COPD-PS questionnaire when used alone. Our findings show that patients with more symptoms (scores of ≥5) yielded twice the percentage of outcomes of FEV1/FEV6 <0.75 compared to patients with fewer COPD symptoms (scores <5). CONCLUSION With the availability of a simple screening questionnaire and the COPD-6, there is an opportunity easily to make patients more aware of their lung symptoms and to encourage the provision of early treatment. The proposed dual assessment approach, which we termed the VitalQPlus, may play a profound role in the early diagnosis of COPD, which is crucial in improving the clinical management of the disease.
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Affiliation(s)
- Chee Fai Sui
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Long Chiau Ming
- Faculty of Pharmacy, Universiti Teknologi MARA, UiTM, Selangor, Malaysia ; Brain Degeneration and Therapeutics Group, Pharmaceutical and Life Sciences (PLS) Community of Research (CoRe), UiTM, Selangor, Malaysia
| | - Chin Fen Neoh
- Faculty of Pharmacy, Universiti Teknologi MARA, UiTM, Selangor, Malaysia ; Collaborative Drug Discovery Research (CDDR) Group, Pharmaceutical and Life Sciences (PLS) Community of Research (CoRe), UiTM, Selangor, Malaysia
| | - Baharudin Ibrahim
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Turkeshi E, Zelenukha D, Vaes B, Andreeva E, Frolova E, Degryse JM. Predictors of poor-quality spirometry in two cohorts of older adults in Russia and Belgium: a cross-sectional study. NPJ Prim Care Respir Med 2015; 25:15048. [PMID: 26201999 PMCID: PMC4532161 DOI: 10.1038/npjpcrm.2015.48] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 04/17/2015] [Accepted: 06/05/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Spirometry is an important test for the diagnosis of respiratory diseases, yet it is underused especially in older adults. Several predictors of good-quality spirometry in this age group have been reported, based mainly on in/outpatients of geriatric and/or respiratory units. AIMS This study aims to assess predictors of poor-quality spirometry in community-dwelling older adults from two primary care cohorts in Russia and Belgium. METHODS Spirograms from two population-based cohort studies in Russia (CRYSTAL) and Belgium (BELFRAIL) were assessed in accordance with the American Thoracic Society/European Respiratory Society (ATS/ERS) acceptability and repeatability criteria and grouped into good and poor quality. Multivariable analysis assessed the association of poor-quality spirometry with socio-demographics, functional dependency, physical and mental functioning and co-morbidities. RESULTS In all, 43.3% of the 522 BELFRAIL participants (84.71 ± 3.67 years old) and 57.7% of the 605 CRYSTAL participants (75.11 ± 5.97 years old) achieved all ATS/ERS acceptability and repeatability criteria. In both cohorts, those with poor-quality spirometry had lower cognitive function (mini-mental state examination (MMSE) ⩽ 24). After adjustment in multivariable analysis, MMSE ⩽ 24 had an odds ratio for poor-quality spirometry of 1.33 (95% CI = 0.78-2.28) in the BELFRAIL and 1.30 (95% CI = 0.88-1.91) in the CRYSTAL cohort. CONCLUSIONS In community-dwelling older adults, including those over 80 years old, impaired cognition measured by the MMSE may not be an independent predictor of poor-quality spirometry. Further research is needed in this area, and spirometry should be used more often in older adults in primary care.
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Affiliation(s)
- Eralda Turkeshi
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Dmitry Zelenukha
- Department of Family Medicine, North-Western State Medical University, St Petersburg, Russia
| | - Bert Vaes
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Elena Andreeva
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Elena Frolova
- Department of Family Medicine, North-Western State Medical University, St Petersburg, Russia
| | - Jean-Marie Degryse
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
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22
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He Z, Ma Z, Xu Y, Zhang Y, Hu F, Sun Y, Zhou D. Analysis of Forced Expiratory Flow Signals Using the New Luus-Jaakola Optimization Procedure. IEEE Trans Biomed Eng 2015; 62:1644-51. [PMID: 25667348 DOI: 10.1109/tbme.2015.2400227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this study was to estimate forced vital capacity (FVC) by analyzing incomplete forced expiratory flow-time (FEFT) curves using the new Luus-Jaakola (NLJ) optimization procedure. METHODS Complete FEFT curves from 90 subjects with and without respiratory disease were used to validate the method, and its application performance was evaluated by FEFT curves containing incomplete curves from nine obstructive patients. First, a lumped parameter model of the FEFT curve, taking FVC as one of the model parameters, is chosen. The 0- 1 s, 0-1.5 s, . . . , 0-6 s curves chosen from the accepted FEFT curves are, respectively, taken as the local system observations. Then, the NLJ optimization procedure was used to get the estimate of FVC (FVCest) by estimating the model parameters. Finally, FVCest was compared with the measured FVC (FVCmea). RESULTS The difference between FVCest and FVCmea decreased with the lengths of observed curves increasing. When the lengths of observed curves reached 3 s, the mean difference (±SD) between FVCest and FVCmea was -11 ± 58 mL. Estimated FVC derived from the incomplete curves were close to FVC from accepted maneuvers. CONCLUSION The method can be used to estimate FVC by analyzing an incomplete FEFT curve, providing the length of the curve is more than 3 s. SIGNIFICANCE This method can help the subjects who cannot complete the forced expiratory maneuver to provide a reliable estimate of FVC and also can be used to analyze the unacceptable spirometry because of early termination of exhalation.
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Effects of comprehensive therapy based on traditional Chinese medicine patterns on older patients with chronic obstructive pulmonary disease: a subgroup analysis from a four-center, randomized, controlled study. Front Med 2014; 8:368-75. [DOI: 10.1007/s11684-014-0360-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/29/2014] [Indexed: 02/02/2023]
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Scichilone N, Pedone C, Battaglia S, Sorino C, Bellia V. Diagnosis and management of asthma in the elderly. Eur J Intern Med 2014; 25:336-42. [PMID: 24445022 DOI: 10.1016/j.ejim.2014.01.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 12/27/2013] [Accepted: 01/03/2014] [Indexed: 12/16/2022]
Abstract
Bronchial asthma is one of the most common chronic diseases worldwide, and by definition not expected to recover with aging. However, the concept that asthma can affect older individuals has been largely denied in the past. In clinical practice, asthma that occurs in the most advanced ages is often diagnosed as COPD, thus leading to undertreatment or improper treatment. The heterogeneity of clinical and functional presentation of geriatric asthma, including the partial loss of reversibility and of the allergic component, contributes to this misconception. A large body of evidence has accumulated demonstrating that the prevalence of asthma in the most advanced ages is similar to that in younger ages. The frequent coexistence of comorbid conditions in older patients compared to younger asthmatics, together with age-associated changes of the human lung, may render the management of asthma a complicated task. The article addresses the main issues related to the diagnosis and treatment of asthma in the geriatric age.
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Affiliation(s)
- Nicola Scichilone
- Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS), University of Palermo, Palermo, Italy.
| | - Claudio Pedone
- Area of Geriatrics, Campus Biomedico University and Teaching Hospital, Rome, Italy
| | - Salvatore Battaglia
- Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS), University of Palermo, Palermo, Italy
| | - Claudio Sorino
- Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS), University of Palermo, Palermo, Italy; U.O. di Pneumologia, Ospedale Sant'Anna, Como, Italy
| | - Vincenzo Bellia
- Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS), University of Palermo, Palermo, Italy
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Incalzi RA, Scarlata S, Pennazza G, Santonico M, Pedone C. Chronic Obstructive Pulmonary Disease in the elderly. Eur J Intern Med 2014; 25:320-8. [PMID: 24183233 DOI: 10.1016/j.ejim.2013.10.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 06/21/2013] [Accepted: 10/04/2013] [Indexed: 11/21/2022]
Abstract
The prevalence of Chronic Obstructive Pulmonary Disease (COPD) dramatically increases with age, and COPD complicated by chronic respiratory failure may be considered a geriatric condition. Unfortunately, most cases remain undiagnosed because of atypical clinical presentation and difficulty with current respiratory function diagnostic standards. Accordingly, the disease is under-recognized and undertreated. This is expected to impact noticeably the health status of unrecognized COPD patients because a timely therapy could mitigate the distinctive and important effects of COPD on the health status. Comorbidity also plays a pivotal role in conditioning both the health status and the therapy of COPD besides having major prognostic implication. Several problems affect the overall quality of the therapy for the elderly with COPD, and current guidelines as well as results from pharmacological trials only to some extent apply to this patient. Finally, physicians of different specialties care for the elderly COPD patient: physician's specialty largely determines the kind of approach. In conclusion, COPD, in itself a complex disease, becomes difficult to identify and to manage in the elderly. Interdisciplinary efforts are desirable to provide the practicing physician with a multidisciplinary guide to the identification and treatment of COPD.
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Affiliation(s)
- Raffaele Antonelli Incalzi
- Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio-Medico University and Teaching Hospital, Rome, Italy; San Raffaele - Cittadella della Carità Foundation, Taranto, Italy.
| | - Simone Scarlata
- Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Giorgio Pennazza
- Center for Integrated Research - CIR, Unit of Electronics for Sensor Systems, Campus Bio-Medico University, Rome, Italy
| | - Marco Santonico
- Center for Integrated Research - CIR, Unit of Electronics for Sensor Systems, Campus Bio-Medico University, Rome, Italy
| | - Claudio Pedone
- Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
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Miravitlles M, Soriano JB, Almagro P. In response to: Martínez-Velilla N. GesEPOC guidelines and elderly patients. Arch Bronconeumol 2013; 50:155. [PMID: 24125824 DOI: 10.1016/j.arbres.2013.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 09/02/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Marc Miravitlles
- Servicio de Neumología, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, España.
| | | | - Pere Almagro
- Unidad de Geriatría de Agudos, Servicio de Medicina Interna, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
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Albers F, Shaikh A, Iqbal A. Design, rationale, and baseline demographics of SEARCH I: a prospective cluster-randomized study. Int J Chron Obstruct Pulmon Dis 2012; 7:437-45. [PMID: 22848157 PMCID: PMC3402060 DOI: 10.2147/copd.s31418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Questionnaires are available to identify patients at risk for several chronic diseases, including COPD, but are infrequently utilized in primary care. COPD is often underdiagnosed, while at the same time the US Preventive Services Task Force recommends against spirometric screening for COPD in asymptomatic adults. Use of a symptom-based questionnaire and subsequent handheld spirometric device depending on the answers to the questionnaire is a promising approach to identify patients at risk for COPD. Screening, Evaluating and Assessing Rate CHanges of diagnosing respiratory conditions in primary care 1 (SEARCH I) was a prospective cluster-randomized study in 168 US primary care practices evaluating the effect of the COPD-Population Screener (COPD-PS™) questionnaire. The effect of this questionnaire alone or sequentially with the handheld copd-6TM device was evaluated on new diagnoses of COPD and on respiratory diagnostic practice patterns (including referrals for pulmonary function testing, referrals to pulmonologists, new diagnoses of COPD, and new respiratory medication prescriptions). Participating practices entered a total of 9704 consecutive consenting subjects aged ≥ 40 years attending primary care clinics. Study arm results were compared for new COPD diagnosis rates between usual care and (1) COPD-PS plus copd-6 and (2) COPD-PS alone. A cluster-randomization design allowed comparison of the intervention effects at the practice level instead of individuals being the subjects of the intervention. Regional principal investigators controlled the flow of study information to sub-investigators at participating practices to reduce observation bias (Hawthorne effect). The results of SEARCH I, to be published subsequently, will provide insight into the real world utility of the COPD-PS as well as two-stage COPD case finding with COPD-PS and copd-6.
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Affiliation(s)
- Frank Albers
- Medical Affairs Respiratory, Field Based Medicine-Respiratory, Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT 06877, USA.
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Scarlata S, Costanzo L, Giua R, Pedone C, Incalzi RA. Diagnosis and prognostic value of restrictive ventilatory disorders in the elderly: A systematic review of the literature. Exp Gerontol 2012; 47:281-9. [DOI: 10.1016/j.exger.2012.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 02/09/2012] [Accepted: 02/10/2012] [Indexed: 10/28/2022]
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Cesari M, Pedone C, Chiurco D, Cortese L, Conte ME, Scarlata S, Incalzi RA. Physical performance, sarcopenia and respiratory function in older patients with chronic obstructive pulmonary disease. Age Ageing 2012; 41:237-41. [PMID: 22156558 DOI: 10.1093/ageing/afr167] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Matteo Cesari
- Università Campus Biomedico-Cattedra di Geriatria, Via dei Compositori 128, Roma 00128, Italy
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Practical management problems of stable chronic obstructive pulmonary disease in the elderly. Curr Opin Pulm Med 2012; 17 Suppl 1:S43-8. [PMID: 22209930 DOI: 10.1097/01.mcp.0000410747.20958.39] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) is one of the most prevalent and increasing health problems in the elderly on a worldwide scale. The management of COPD in older patients presents practical diagnostic and treatment issues, which are reviewed with reference to the stable stage of the disease. RECENT FINDINGS In the diagnostic approach of COPD in the elderly the use of spirometry is recommended, but both patient conditions (such as inability to correctly perform it due to fatigue, lack of coordination, and cognitive impairment) and metrics characteristics should be taken into account for the test performance. It has been demonstrated in population studies that the use of the fixed ratio determines a substantial overdiagnosis of COPD in the oldest patients. Other parameters have been suggested [such as the evaluation of Lower Limit of Normality (LLN) for the FEV1/FVC ratio], which may be useful to guide the diagnosis. Several nonpharmacologic - such as smoking cessation, vaccination, physical activity, and pulmonary rehabilitation, nutrition, and eventually invasive ventilation - and pharmacologic interventions have been shown to improve outcomes and have been reviewed. Effective management of COPD in older adults should always consider the ability of patients to properly use inhalers and the involvement of caregivers or family members as a useful support to care, especially when treating cognitively impaired patients. Especially in the older population, timely identification and treatment of comorbidities are also crucial, but evidence in this area is still lacking and clinical practice guidelines do not take comorbidities into account in their recommendations. SUMMARY The Global Initiative for Obstructive Lung Disease has recommended criteria for diagnosis and management of COPD in the general population. On the contrary, available evidence suggests practical limitations in diagnostic approach and intervention strategies in older patients with stable COPD that need to be further studied for a translation into clinical practice guidelines.
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Güder G, Brenner S, Angermann CE, Ertl G, Held M, Sachs AP, Lammers JW, Zanen P, Hoes AW, Störk S, Rutten FH. "GOLD or lower limit of normal definition? A comparison with expert-based diagnosis of chronic obstructive pulmonary disease in a prospective cohort-study". Respir Res 2012; 13:13. [PMID: 22309369 PMCID: PMC3299632 DOI: 10.1186/1465-9921-13-13] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 02/06/2012] [Indexed: 11/16/2022] Open
Abstract
Background The Global initiative for chronic Obstructive Lung Disease (GOLD) defines COPD as a fixed post-bronchodilator ratio of forced expiratory volume in 1 second and forced vital capacity (FEV1/FVC) below 0.7. Age-dependent cut-off values below the lower fifth percentile (LLN) of this ratio derived from the general population have been proposed as an alternative. We wanted to assess the diagnostic accuracy and prognostic capability of the GOLD and LLN definition when compared to an expert-based diagnosis. Methods In a prospective cohort study, 405 patients aged ≥ 65 years with a general practitioner's diagnosis of COPD were recruited and followed up for 4.5 (median; quartiles 3.9; 5.1) years. Prevalence rates of COPD according to GOLD and three LLN definitions and diagnostic performance measurements were calculated. The reference standard was the diagnosis of COPD of an expert panel that used all available diagnostic information, including spirometry and bodyplethysmography. Results Compared to the expert panel diagnosis, 'GOLD-COPD' misclassified 69 (28%) patients, and the three LLNs misclassified 114 (46%), 96 (39%), and 98 (40%) patients, respectively. The GOLD classification led to more false positives, the LLNs to more false negative diagnoses. The main predictors beyond the FEV1/FVC ratio for an expert diagnosis of COPD were the FEV1 % predicted, and the residual volume/total lung capacity ratio (RV/TLC). Adding FEV1 and RV/TLC to GOLD or LLN improved the diagnostic accuracy, resulting in a significant reduction of up to 50% of the number of misdiagnoses. The expert diagnosis of COPD better predicts exacerbations, hospitalizations and mortality than GOLD or LLN. Conclusions GOLD criteria over-diagnose COPD, while LLN definitions under-diagnose COPD in elderly patients as compared to an expert panel diagnosis. Incorporating FEV1 and RV/TLC into the GOLD-COPD or LLN-based definition brings both definitions closer to expert panel diagnosis of COPD, and to daily clinical practice.
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Affiliation(s)
- Gülmisal Güder
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Frith P, Crockett A, Beilby J, Marshall D, Attewell R, Ratnanesan A, Gavagna G. Simplified COPD screening: validation of the PiKo-6® in primary care. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2011; 20:190-8, 2 p following 198. [PMID: 21597667 DOI: 10.4104/pcrj.2011.00040] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIMS To determine the accuracy of the forced expiratory volume ratio at one and six seconds (FEV1/FEV6) using a hand-held, expiratory flow meter (PiKo-6®, nSpire Health, Inc.) to screen for chronic obstructive pulmonary disease (COPD) in primary care settings. METHODS Current and former smokers (≥ 50 years old) with no previous respiratory diagnosis (case finding [CF] = 204 subjects) or with an asthma diagnosis (differential diagnosis [DD] = 93 subjects) were evaluated using validated questionnaires, pre-bronchodilator (BD) FEV1/FEV6 and post-BD FEV1/forced vital capacity (FVC) spirometry. RESULTS The PiKo-6® FEV1/FEV6 showed good sensitivity and specificity (areas under the Receiver Operating Characteristic curves [95% confidence intervals]: CF = 0.85 [0.79, 0.90]; DD = 0.88 [0.80, 0.96]) and exceeded the accuracy of the questionnaires. An FEV1/FEV6 cutoff < 0.75 provided optimal sensitivity (CF = 81%; DD = 86%) and specificity (CF = 71%; DD = 67%) for COPD screening. CONCLUSIONS The PiKo-6® allows simple and reliable screening for COPD which could optimise early referral for spirometry and early, targeted interventions for COPD.
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Affiliation(s)
- Peter Frith
- Southern Respiratory Services, Repatriation General Hospital, Adelaide, South Australia, Australia.
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Khanmohammadi M, Garmarudi AB. Infrared spectroscopy provides a green analytical chemistry tool for direct diagnosis of cancer. Trends Analyt Chem 2011. [DOI: 10.1016/j.trac.2011.02.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Kishi H, Shibata Y, Osaka D, Abe S, Inoue S, Tokairin Y, Igarashi A, Yamauchi K, Kimura T, Sato M, Aida Y, Watanabe T, Konta T, Kawata S, Kato T, Kubota I. FEV6 and FEV1/FEV6 in Japanese participants of the community-based annual health check: the Takahata study. Intern Med 2011; 50:87-93. [PMID: 21245630 DOI: 10.2169/internalmedicine.50.4276] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Forced expiratory volume in 6 seconds (FEV(6)) is becoming a substitute of forced vital capacity (FVC). However, the Japanese predictive equation for FEV(6) has not been established, and the validity for the use of FEV(1)/FEV(6) for diagnosing airflow limitation in Japanese has not been confirmed. METHODS Subjects aged 40 or older, who had participated in a community-based health check in Takahata, Japan, from 2004 through 2005, were enrolled. The smoking histories of these subjects were investigated using a self-reporting questionnaire. FVC, FEV(1), and FEV(6) were measured using spirometric machines. Predictive equations of FEV(6) were obtained from never-smoking subjects without history of pulmonary diseases by multiple linear regression assay. RESULTS FEV(6) and FEV(1)/FEV(6) were significantly correlated with FVC (r=0.998, p<0.001) and FEV(1)/FVC (r=0.989, p<0.001), respectively. The cutoff values of percent predicted (%) FEV(6) and FEV(1)/FEV(6) for discrimination of having the restrictive lung disorder determined by %FVC <0.8 and having the airflow limitation determined by FEV(1)/FVC <0.7 were 0.80 and 0.72, respectively (%FEV(6): sensitivity=0.995, specificity=0.983, positive predictive value <PPV>=0.832, negative predictive value <NPV>=1.000; FEV(1)/FEV(6): sensitivity=0.942; specificity=0.971; PPV=0.787; NPV=0.993). When the 5th percentile the lower limit of normal values was used as criterion for discrimination of having airflow limitation, sensitivity, specificity, PPV, and NPV of FEV(1)/FEV(6) were 0.932, 0.985, 0.808, and 0.995, respectively. CONCLUSION The results of the present study suggest that %FEV(6) and FEV(1)/FEV(6) are excellent substitutes for %FVC and FEV(1)/FVC, respectively. We confirmed the validity of the use of FEV(6) and FEV(1)/FEV(6) for identifying pulmonary diseases in Japanese individuals.
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Affiliation(s)
- Hiroyuki Kishi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
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Sorino C, Sherrill D, Guerra S, Enright P, Pedone C, Augugliaro G, Scichilone N, Battaglia S, Antonelli-Incalzi R, Bellia V. Prognostic value of FEV1/FEV6 in elderly people. Clin Physiol Funct Imaging 2010; 31:101-7. [PMID: 20969726 DOI: 10.1111/j.1475-097x.2010.00984.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The ratio of forced expiratory volume in 1 s and forced expiratory volume in 6 s (FEV1/FEV6) has been proposed as an alternative for FEV1/forced vital capacity (FVC) to diagnose obstructive diseases with less effort during spirometry; however, its prognostic value is unknown. We evaluated whether FEV1/FEV6 is a significant predictor of mortality in elderly subjects and compared its prognostic value with that of FEV1/FVC and FEV1. METHODS One thousand nine hundred and seventy-one subjects, aged >65 years, participated in the population-based SA.R.A. study. During the baseline exam, a multidimensional assessment included spirometry. Vital status was determined during 6 years of follow-up. Association of all-cause, cardio-pulmonary (CP) and non-CP mortality with a low FEV1/FEV6, FEV1/FVC and FEV1 was evaluated. RESULTS Among subjects with both survival data and acceptable spirometry including FEV6, all-cause unadjusted mortality rates were 7·00 and 2·46 per 100 person-years in subjects with FEV1/FEV6 less than and greater than or equal to lower limit of normal (LLN), respectively (mortality rate ratio: 2·84, 95%CI: 2·12-3·84). After adjustment for age, gender, FVC, smoke exposure and main comorbidities, the risk of all-cause mortality remained significantly increased in subjects with FEV1/FEV6<LLN [hazard ratio (HR): 1·87, 95%CI: 1·35-2·58] as well as in subjects with FEV1/FVC<LLN (HR: 2·01, 95%CI: 1·51-2·90) and FEV1<LLN (HR: 2·17, 95%CI: 1·32-3·57). Similar results were found for CP mortality, but not for non-CP mortality. CONCLUSIONS A low FEV1/FEV6 is a significant predictor of mortality in older individuals. Its prognostic value is comparable to that of a low FEV1/FVC and FEV1.
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Affiliation(s)
- Claudio Sorino
- Department of Medicine, Pneumology, Physiology and Human Nutrition, University of Palermo, via Trabucco 180, Palermo, Italy.
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Arne M, Lisspers K, Ställberg B, Boman G, Hedenström H, Janson C, Emtner M. How often is diagnosis of COPD confirmed with spirometry? Respir Med 2010; 104:550-6. [DOI: 10.1016/j.rmed.2009.10.023] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 10/27/2009] [Accepted: 10/28/2009] [Indexed: 10/20/2022]
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Jing JY, Huang TC, Cui W, Xu F, Shen HH. Should FEV1/FEV6 replace FEV1/FVC ratio to detect airway obstruction? A metaanalysis. Chest 2009; 135:991-998. [PMID: 19349398 DOI: 10.1378/chest.08-0723] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The conventional FEV(1)/FVC test is the "gold standard" to quantitate airway obstruction, but elderly subjects or patients with severe respiratory diseases quite frequently cannot make such an effort. Many studies have investigated the usefulness of FEV(1)/forced expired volume in 6 s (FEV(6)) measurements as an alternative for FEV(1)/FVC for diagnosis of airway obstruction. We conducted a meta-analysis to determine the FEV(1)/FEV(6) substitute for FEV(1)/FVC in the diagnosis of airway obstruction. METHODS After a systematic review of all-language studies, sensitivity, specificity, and other measures of accuracy of FEV(1)/FEV(6) in the diagnosis of airway obstruction were pooled using random-effects models. Summary receiver operating characteristic curves were used to summarize overall test performance. RESULTS Eleven studies met our inclusion criteria. The summary estimates for FEV(1)/FEV(6) in the diagnosis of airway obstruction in the studies included were as follows: sensitivity, 0.89 (95% confidence interval [CI], 0.83 to 0.93); specificity, 0.98 (95% CI, 0.95 to 0.99); positive likelihood ratio, 45.46 (95% CI, 18.26 to 113.21); negative likelihood ratio, 0.11 (95% CI, 0.08 to 0.17); diagnostic odds ratio, 396.02 (95% CI, 167.32 to 937.31); and diagnostic score, 5.98 (95% CI, 5.12 to 6.84). CONCLUSIONS FEV(1)/FEV(6) is a sensitive and specific test for the diagnosis of airway obstruction. FEV(1)/FEV(6) can be used as a valid alternative for FEV(1)/FVC in the diagnosis of airway obstruction.
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Affiliation(s)
- Ji-Yong Jing
- Respiratory Department, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Tian-Cha Huang
- Intensive Care Unit, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Wei Cui
- Intensive Care Unit, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Feng Xu
- Respiratory Department, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Hua-Hao Shen
- Respiratory Department, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China.
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Zelter M. La spirométrie simplifiée ; est-ce si simple ? Rev Mal Respir 2009; 26:249-52. [DOI: 10.1016/s0761-8425(09)72579-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Allen S, Yeung P, Janczewski M, Siddique N. Predicting inadequate spirometry technique and the use of FEV1/FEV3 as an alternative to FEV1/FVC for patients with mild cognitive impairment. CLINICAL RESPIRATORY JOURNAL 2008; 2:208-13. [DOI: 10.1111/j.1752-699x.2008.00063.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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